Soft Tissue Injuries – Wounds – Dressings and Bandages

Upon completion of this lesson, you will be able to:

• List two steps to treat a closed wound.
• List six steps to treat an open wound.
• List the steps for pre-hospital treatment for the eye, ear, nose and mouth Soft Tissue Injuries.
• List the steps for pre-hospital treatment of abdominal and genital injuries.
• Demonstrate the use of dressings and bandages to control bleeding when given a specific area of the body.
• Demonstrate the pre-hospital treatment procedures for the following:
  • Impaled object in the eye or cheek
  • Bleeding neck injuries
  • Extruded eyeball

1. Soft Tissue Injuries Definition

Soft tissue injuries, commonly referred to as wounds, are  Injuries to the skin, muscle, nerves, and blood vessels

2. Closed Wounds

Closed wound: Injury to the soft tissues beneath unbroken skin.

Closed wounds can involve superficial damage to the skin or can be severe with damage to internal organs.

Small contusions generally do not need treatment, whereas more

serious injuries can be fatal Closed wounds are generally caused by impact with a larger end object.

How to recognize closed wounds.

• Swelling
• Tenderness
• Discoloration
• Possible deformity

3.Pre-hospital treatment for closed wounds

Use universal precautions and secure the scene.

1. Apply the “RICE” method: rest, ice, compress, elevate.
2. Monitor the patient for any that might indicate internal bleeding, which should be treated by a physician.
3. Treat for shock
4. Transport the patient as soon as possible.
5. Prevent contamination. Remove debris and contamination around the surface of the wound.
6. Do not try to remove embedded particles.
7. Dress and bandage
8.  Cover the patient
9. Treat for shock.

Transport the patient as soon as possible.

4. Dressings and Bandages

Dressing: Any material used to cover a wound that helps control bleeding and first aids in the prevention of additional bleeding and lose.

Bandage: Any material used to hold a dressing in place of the wound. A Bandage may be a strip of woven material used to adhere to a wound or to protect a wounded part of the body.

Occlusive dressing: Any water-resistant material (plastic or waxed paper) applied to a wound to prevent the entrance of air and the loss of moisture from internal organs.

Bulky dressing: Multiple stacked dressings made to form single dressing 2-3 cm thick, such as a thick sanitary towel any similar material.

4.1 Applying Dressings and Bandages

When applying a bandage and dressing you should be able to:

• Control bleeding.
• Apply the dressings using aseptic technique.
• Cover the wounds completely
• Ensure that the dressing and the bandage are firm, fixed and comfortable, but not so tight as to affect circulation.
• Ensure there are no loose ends that can get caught
• Avoid covering the fingertips

Pre-hospital treatment of wounds and soft tissue injuries is directed at controlling bleeding and preventing contamination.

4.2 Bandaging Unusual Wounds Penetrating Injury

1. Cover any open wound completely.
2. Examine the patient for a possible exit wound.

Impaled Objects

1. Do not remove unless impaled in the cheek or affecting the airway or CPR
2. Control bleeding
3. Stabilize the object with a bulky dressing and apply a bandage.

Avulsion (skin flap)

1. Clean the wound surface
2. Return skin flap to the original position
3. Control bleeding
4. Cover with bulky dressing and apply a bandage

Amputations and  unattached avulsions

1. Clean the wound
2. Control bleeding
3. Apply dressing and bandages
4. Keep amputated part cold and moist, but not wet.

5. Special Situations

5.1 Injuries to the Scalp

Suspect spinal injury in any patient with a head injury. Do not apply direct pressure if you suspect a skull fracture.

5.2 Wounds to the Eyes (puncture wound or impaled object)

1. Bandage the good eye to prevent movement of the injured eye.
2. In an unconscious patient, close the eyes before blindfolding the patient to prevent the eyes from drying, which may cause blindness.
3. Treat an extruded eye the same way as you would treat an eye with an impaled object. Do not replace the eye if it has been expelled. Cover it with a cup or cardboard cone before applying the bandage

Read also: Hemorrhage and Shock treatment

5.3 Injuries to the Ear

Blood, clear fluid, or blood-tinged fluid draining from the ear may indicate skull fracture or severe head trauma

• Never probe the ear
• Never pack the ear to stop bleeding; check for clear fluid (cerebrospinal fluid, or CSF) which may indicate a skull fracture from the ear canal.
• Place a loose clean dressing across the opening to absorb the fluids.
• Do not apply pressure.

5.4 Nosebleed

A nosebleed is an emergency that can be serious and should not be neglected. The loss of blood can be great and lead to shock. If the patient has a suspected skull fracture or spinal injury, do not try to

(This topic will be discussed in more detail in the lesson on skull injuries.)

Pre-hospital treatment for nosebleeds

Use universal precautions and secure the scene.

1. Maintain an open airway.
2. Pinch nostrils together or place a dressing between the upper lip and the gum and apply pressure.
3. Keep the patient seated and still.
4. Do not pack the nose, check for clear fluid (CSF) which may indicate a skull fracture
5. Do not remove any object you may find inside the nose.
6. For avulsions, apply a compressive dressing

5.5 Injuries to the Mouth

Pre-hospital treatment for injuries to the mouth

Use universal precautions and secure the scene

1. Maintain an open airway. For cut lips, use a rolled or folded dressing. Place the dressing between the patient’s lip and gum. Ensure the dressing does not come loose and enter the airway; this dressing should not be swallowed.

2. For avulsed lips, apply a pressure bandage to the site of injury.

3. For cut to the internal cheek, position a dressing between the patient’s cheek and gum. Hold the dressing in place with a gloved hand and do not pack the mouth with dressing. Leave 3-4 inches of dressing material outside the patient’s mouth for quick removal. If possible, position the patient’s head to allow drainage

5.6 Injuries to the Neck

• Visible lacerations or other wounds can produce massive bleeding or air embolism.
• Difficulty speaking, loss of voice.
• Airway obstructions without foreign bodies in mouth, nose, or airway. Often caused by inflammatory
• process (subcutaneous emphysema)
• Tracheal deviation.
• Deformities or depressions.
• Immobilize the patient if you suspect a spinal injury.

Pre-hospital treatment for injuries to the neck

Use universal precautions and secure the scene.

1. If there is bleeding from a neck wound, do not delay treatment, cover injury with a gloved hand and apply direct pressure if necessary,

• Apply slight to moderate pressure with an occlusive dressing.
• Tape down all edges of the dressing to form an airtight seal, to avoid air embolism.
• Add a bulky dressing over the occlusive one

2. For a patient without spinal injury, place the patient on the left side with a 15-degree incline (head lower), if possible

3.If an object is impaled in the neck, stabilize it in place with bulky dressings Do not remove it

4. Treat for shock.

What not to do:

• Never apply pressure to both sides of the neck at the same time.
• Never apply a pressure dressing completely around the neck.

IMPORTANT: With any head. face, scalp, eye, ear, nose or neck injury, the MFR should also suspect a possible spinal injury.

5.7 Injuries to the Abdomen

The abdomen contains solid and hollow organs. The rupture of _______organs (stomach, large and small intestine) can cause the contents (acids, digestive enzymes, bacteria) to spill into the peritoneal cavity, causing an inflammatory reaction Rupture of

the _______ organs (liver, spleen, etc ) can cause severe hemorrhage

A contusion may indicate injury to the abdomen or pelvis.

Signs and symptoms of abdominal injury

• Pain or cramps in the abdominal area, local or diffuse
• Guarding the abdomen or lying down in foetal position
• Tenderness of the abdomen
• Signs of shock
• Rigid, tense or distended abdomen
• Mild discomfort progressing to intolerable pain
• Deep, penetrating pain in the pelvis or lower back
• Pain radiating to a shoulder or both shoulders
• Vomiting blood bright red or like coffee grounds
• Blood in the stool, bright red or tarry black.

Pre-hospital treatment for abdominal injuries

Use universal precautions and secure the scene. Be alert for patient vomiting.

1. Cover all open wounds.
2. Do not replace exposed internal organs – cover them with thick, moist sterile dressing Then loosely cover the moist dressing with an occlusive dressing. Keep the exposed area warm by placing a dressing or towel over the occlusive dressing.
3. Do not remove impaled objects – stabilize them with bulky dressings.
4. Constantly monitor vital signs.
5. Place the patient supine with legs in the most comfortable position.
6. Treat for shock.

5.8 Injuries to the Genitals

Pre-hospital treatment for wounds to genitalia

Wounds to the genitals should be treated the same as any other wound. However, special care and attention should be given to protect the patient’s privacy.

(to be used in Station 2. Applying Tourniquet)

 

Blunt trauma: An ice pack, if available, can help.

Cuts: Bleeding should be controlled by direct pressure A sterile dressing or a sanitary pad should be used. If either is not available, then use any clean, bulky dressing.